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"Latar belakang: Pasien yang dinyatakan masuk kedalam kategori “Suspect COVID-19” adalah jika seseorang memiliki beberapa tanda yaitu demam, sakit tenggorokkan, batuk, menderita ISPA, dan memiliki kontak dengan pasien yang sudah terkonfirmasi positif COVID-19. Untuk memilah agar ruang gawat darurat digunakan untuk pasien yang cukup parah gejalanya, pihak rumah sakit melakukan identifikasi kepada pasien dengan suspect COVID-19 sehingga mengetahui tatalaksana yang tepat untuk pasien dan mendahulukan pasien yang membutuhkan perawatan intensif. Untuk melihat peluang pasien yang termasuk kategori suspect COVID-19 menjadi terkonfirmasi positif COVID-19 kita dapat meneliti hasil lab darah perifer lengkap pada pasien. Beberapa penelitian melihat morfologi dari masing-masing darah perifer lengkap dimana terlihat adanya abnormalitas morfologi pada pemeriksaan darah perifer lengkap dengan mikroskop. Untuk menjadikan hasil lab darah perifer lengkap sebagai parameter untuk mempresiksi diagnosis, prognosis, dan melihat adanya perubahan hasil lab darah perifer lengkap pasien suspect dengan pasien terkonfirmasi dibutuhkan waktu yang cukup lama jika dilihat dari morfologinya maka dari itu diperlukan analisis kadar dari masing-masing darah perifer.Metode: Penelitian ini menggunakan metode potong lintang komparatif dua kelompok. Subjek merupakan pasien Rumah Sakit Umum Pusat Persahabatan. Data Pasien diperoleh pada Bulan Juni 2021 dimana kasus COVID-19 sedang bertambah cukup pesat hingga Januari 2022 dimana penyebaran COVID-19 mulai surut. Pasien memiliki komorbid seperti diabetes,hipertensi, dan penyakit ginjal kronik. Rekam medis pasien dilihat hanya dari profil darah lengkap yaitu hemoglobin, leukosit, neurofil, limfosit, monosit, dan trombosit.Hasil: Jumlah pasien suspect COVID-19 berjumlah 51 pasien dan jumlah pasien terkonfirmasi COPVID-19 berjumlah 47 pasien. Dilihat dari profil darah perifer lengkap terdapat persebaran jumlah hemoglobin normal sebanyak 50 % dari seluruh subjek penelitian serta jumlah hemoglobin rendah sebanyak 39,7% dari seluruh subjek penelitian. Terdapat persebaran jumlah leukosit normal sebanyak 55,1% dari seluruh subjek penelitian serta jumlah leukosit tinggi sebanyak 35,7% dari seluruh subjek penelitian. Terdapat persebaran jumlah neutrofil tinggi sebanyak 51,0% dan jumlah lelukosit normal sebanyak 42,8% dari seluruh subjek penelitian. Terdapat persebaran jumlah limfosit rendah sebanyak 64,2% dan jumlah limfosit normal sebanyak 31,6% dari seluruh subjek penelitian. Terdapat persebaran jumlah monosit normal sebanyak 59,1% dan jumlah monosit tinggi sebanyak 34,6% dari seluruh subjek penelitian. Terdapat persebaran jumlah normal sebanyak 70,4% dan jumlah trombosit tinggi sebanyak 25,5% dari seluruh subjek penelitian. Hubungan antara profil darah perifer lengkap dengan proporsi pasien suspect COVID-19 dengan pasien terkonfirmasi COVID-19 menunjukkan adanya hubungan (p>0,05).Kesimpulan: Adanya hubungan antara profil darah perifer lengkap pada proporsi pasien suspect COVID-19 dengan pasien terkonfirmasi COVID-19

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Introduction: Patients who are declared to be in the "Suspect COVID-19" category are if someone has several signs, namely fever, sore throat, cough, suffering from ARI, and has contact with patients who have been confirmed positive for COVID-19. To sort out that the emergency room is used for patients whose symptoms are quite severe, the hospital identifies patients with suspected COVID-19 so that they know the right treatment for patients and prioritize patients who need intensive care. To see the chances of a patient belonging to the suspect category of COVID-19 being confirmed positive for COVID-19, we can examine the results of the complete peripheral blood lab on the patient. Several studies looked at the morphology of each complete peripheral blood where there were morphological abnormalities on complete peripheral blood examination with a microscope. To make the complete peripheral blood lab results as a parameter for predicting diagnosis, prognosis, and seeing any changes in the complete peripheral blood lab results from suspect patients with confirmed patients, it takes quite a long time when viewed from the morphology, therefore it is necessary to analyze the levels of each peripheral blood .

Method: This study used a two-group comparative cross-sectional method. The subject is a patient in RSUP Persahabatan. Patient data was obtained in June 2021 where COVID- 19 cases were growing quite rapidly until January 2022 where the spread of COVID-19 began to recede. Patients have comorbidities such as diabetes, hypertension, and chronic kidney disease. The patient's medical record is seen only from the complete blood profile, namely hemoglobin, leukocytes, neurophiles, lymphocytes, monocytes, and platelets.

Result: The number of suspected COVID-19 patients is 51 patients and the number of confirmed COPVID-19 patients is 47 patients. Judging from the complete peripheral blood profile, there was a normal distribution of hemoglobin in 50% of all research subjects and 39.7% of low hemoglobin in all research subjects. There is a distribution of normal leukocyte counts as much as 55.1% of all research subjects and high leukocyte counts as much as 35.7% of all research subjects. There was a distribution of high neutrophil counts as much as 51.0% and normal leukocyte counts as much as 42.8% of all research subjects. There was a distribution of 64.2% low lymphocyte count and 31.6% normal lymphocyte count of all research subjects. There was a distribution of the normal monocyte count as much as 59.1% and the high monocyte count as much as 34.6% of all research subjects. There was a normal distribution of 70.4% and a high platelet count of 25.5% of all research subjects. The relationship between complete peripheral blood profile and the proportion of suspected COVID-19 patients with confirmed COVID-19 patients showed a relationship (p>0.05).

Conclusion: There is a relationship between complete peripheral blood profile in the proportion of patients suspected of COVID-19 with confirmed patients of COVID-19"

"Latar belakang: Mekanisme penyebab kematian COVID-19 adalah terjadinya hipoksemia dan ARDS. Salah satu komponen dalam penilaian ARDS adalah hasil Annalisis Gas Darah (AGD) dan nilai perbedaan tekanan parsial oksigen di arteri dan alveolus yang dikenal sebagai AaDO2. Peran nilai analisis gas darah dan AaDO2 pada luaran meninggal COVID-19 perlu di telaah lebih lanjut.Metode penelitian: Analisis deskriptif kohort retrospektif terhadap pasien COVID-19 terkonfirmasi yang dirawat di RSUP Persahabatan secara consecutive sampling dari bulan maret sampai dengan agustus 2020. Kami meninjau 205 rekam medis pasien terkonfirmasi yang telah memenuhi kriteria inklusi.Hasil: Median dan rentang nilai pH, PaCO2, PaO2, HCO3, BE, SaO2, FiO2, SpO2 adalah 7,41(7,01-7,54), 32,1(17,5-87,1), 73,9(22,7-343,7), 21(7,2-38,9), -3,8(-22,2-13,3), 94,9(33,5-99,9), 0,54(0,21-1,00), 95(33,5-99,9) secara berurutan. Terapi oksigen yang digunakan pasien adalah masker oksigen nonhirup ulang sebesar 37,56% diikuti dengan kanula hidung sebesar 32,20%, ventilator mekanis sebesar 16,59%, kanula hidung arus tin ggi sebesar 10,73%, masker sederhana sebesar 0,98% dan masker venturi sebesar 0,49%. Median nilai AaDO2 sebesar 272,58% (40,55-644,17). Derajat penyakit klinis terbanyak memiliki derajat klinis kritis sebesar 93,2%. Gangguan asam basa yang dialami pasien adalah 33,51% mengalami gangguan asam basa campuran, 22% mengalami gangguan asidosis metabolik tidak terkompensasi dan 25% pasien mengalami asidosis repiratorik terkompensasi. Terdapat korelasi parameter PaO2, BE, SaO2, FiO2, PAO2 dan AaDO2 dengan kejadian kematian pasien (p<0,05).

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Background: The cause of death in COVID-19 is hypoxemia in acute respiratory distress syndrome (ARDS). This condition could be assessed through arterial blood gas analysis by determining the alveolar arterial oxygen gradient value (AaDO2). The role of arterial blood gas analysis and AaDO2 to predict mortality in COVID-19 is yet to be explored.

Methods: We performed observational retrospective cohort analysis of COVID-19 confirmed patients treated at Persahabatan Hospital, Jakarta, Indonesia. Subject by means of consecutive sampling were COVID-19 confirmed patients between March and August 2020. We reviewed the medical record of 205 patients whom meet the inclusion criteria.

Results: Median value and range of pH, PaCO2, PaO2, HCO3, BE, SaO2, FiO2, SpO2 were 7.41(7.01-7.54), 32.1(17.5-87.1), 73.9(22.7-343.7), 21(7.2-38.9), -3.8(-22.2-13.3), 94.9(33.5-99.9), 0.54(0.21-1.00) and 95(33.5-99.9). Most of the patients use non-rebreathing mask (37.56%), followed by nasal cannula (32.2%), mechanical ventilator (16.59%), high flow nasal cannula (10.73%), simple mask (0.98%) and venturi mask (0.49%). Median value of AaDO2 was 272.58 (40.55-644.17). Most of the patients were critically ill (93.2%). There were 33.51% patients presented with the mix acid base disorder, 22% with uncompensated metabolic acidosis disorder and 25% with compensated respiratory acidosis disorder. There was a correlatio"

"Latar Belakang: Beberapa studi menunjukkan karakteristik sindrom metabolik berhubungan dengan prognosis yang lebih buruk pada pasien COVID-19. Hal ini meningkatkan pemikiran bahwa resistensi insulin (RI) mempunyai peran penting dalam memediasi keparahan penyakit.Tujuan: Penelitian ini dilakukan untuk mengetahui proporsi dan karakteristik pasien COVID-19 yang terjadi RI, serta untuk menganalisa hubungan antara parameter RI ( HOMA-IR dan indeks TyG) dengan luaran klinis pasien COVID-19.Metode: Dengan subjek penelitian sebanyak 288 orang, desain penelitian ini adalah studi potong lintang untuk hubungan antara parameter RI dengan derajat keparahan COVID-19, dan studi kohort retrospektif untuk hubungan antara parameter RI dengan perburukan derajat penyakit dan/atau mortalitas. Dilakukan analisa multivariat untuk mengetahui pengaruh variabel perancu pada hubungan tersebut.Hasil: Proporsi subjek yang terjadi resistensi insulin lebih kecil daripada yang tidak terjadi (berdasar: HOMA-IR: 42% vs 58%; indeks TyG:43% vs 57%), dan mempunyai karakteristik komorbiditas yang mendominasi adalah DM, sedangkan pada kelompok non resistensi insulin didominasi oleh HT. Pada hubungannya dengan derajat COVID-19 saat admisi, baik HOMA-IR dan indeks TyG secara signifikan lebih tinggi pada COVID-19 derajat berat (asimtomatik-ringan vs sedang vs berat: HOMA-IR=2,71 (1,68-4,02) vs 3,35 (2,06-5,73) vs 6,11 (3,35-10,43), p=0,001; indeks TyG=8,51 (SB 0,75) vs 8,81 (SB 0,73) vs 8,98 (SB 1,03), p=0,002). Perbedaan nilai yang signifikan ini juga didapatkan pada hubungannya dengan terjadinya perburukan (ya vs tidak: HOMA-IR=4,15 (2,89-6,59) vs 2,76 (1,74-4,91), p=<0,001; indeks TyG=8,92 (SB 0,78) vs 8,64 (SB 0,75), p=0,015). Pada analisis multivariat didapatkan indeks TyG berhubungan signifikan dengan derajat COVID-19 saat admisi (fully adjusted OR: 1,984 (1,020-3,860), p=0,044), namun pada HOMA-IR tidak didapatkan hubungan signifikan setelah dilakukan adjustment terhadap variabel perancu. Pada hubungan dengan terjadinya perburukan, baik HOMA-IR maupun indeks TyG tidak terbukti berhubungan signifikan setelah dilakukan adjustment terhadap variabel perancu.Simpulan: Dari temuan bahwa karakteristik antara kelompok RI dan non-RI ternyata mayoritas serupa, belum menimbulkan perbedaan fenotip, menimbulkan pemikiran bahwa kondisi resistensi insulin yang terjadi adalah suatu resistensi insulin akut yang disebabkan COVID-19. Adanya RI yang bersifat akut ini harus diwaspadai oleh para klinisi yang merawat pasien COVID-19. Dengan adanya hubungan signifikan antara indeks TyG dengan derajat COVID-19 saat admisi, disimpulkan indeks TyG dapat menjadi petanda kelainan metabolik yang terjadi akibat infeksi COVID-19.

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Background: Several studies show metabolic syndrome characteristics are associated with a worse prognosis in COVID-19 patients. This increases the idea that insulin resistance (IR) has an important role in mediating the severity of the disease.

Objective: This study was conducted to determine the proportion and characteristics of COVID-19 patients who the IR occur, as well as to analyze the relationship between IR markers (HOMA-IR and TyG index) with the clinical outcomes of COVID-19 patients

Methods: With 288 study subjects, the design of this study was a cross-sectional study for the association between IR parameters and COVID-19 severity, and a retrospective cohort study for the association between IR parameters and worsening degrees of disease and/or mortality. Multivariate analysis was carried out to determine the influence of confounding variables on the association.

Results: The proportion of subjects who occurred insulin resistance was smaller than those that did not occur (based on: HOMA-IR: 42% vs 58%; TyG index:43% vs 57%), and had a predominate comorbidity characteristic was DM, while in the non-insulin resistance group it was dominated by HT. In relation to the degree of COVID-19 at admission, both the HOMA-IR and the TyG index were significantly higher in severe degree COVID-19 (asymptomatic-mild vs moderate vs severe: HOMA-IR=2.71 (1.68-4.02) vs 3.35 (2.06-5.73) vs 6.11 (3.35-10.43), p=0.001; index TyG=8.51 (SB 0.75) vs 8.81 (SB 0.73) vs 8.98 (SB 1.03), p=0.002). This significant difference in values was also found in relation to the occurrence of aggravation (yes vs no: HOMA-IR=4.15 (2.89-6.59) vs 2.76 (1.74-4.91), p=<0.001; TyG index=8.92 (SB 0.78) vs 8.64 (SB 0.75), p=0.015). In the multivariate analysis, the TyG index was significantly associate with the degree of COVID-19 at admission (fully adjusted OR: 1.984 (1.020-3.860), p = 0.044), but in HOMA-IR there was no significant association after adjustments were made to the confounding variable. In association with the occurrence of aggravation, neither the HOMA-IR nor the TyG index proved to be significantly related after adjustments were made to the confounding variables.

Conclusions: From the findings that the characteristics between the IR and non-IR groups turned out to be mostly similar, not yet causing phenotype differences, it gave rise to the thought that the condition of insulin resistance that occurs is an acute insulin resistance caused by COVID-19. The existence of this acute RI must be aware by clinicians who treat COVID-19 patients. With the significant relationship between the TyG index and the degree of COVID-19 at the time of admission, it is concluded that the TyG index can be a map of metabolic abnormalities that occur due to COVID-19 infection.

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"Coronavirus Disease 2019 (COVID-19) disebabkan oleh infeksi virus SARS CoV-2, dan telah dilaporkan banyak menyebabkan kematian di berbagai negara. Pada pasien COVID-19, ditemukan perubahan kadar asam amino, baik asam amino esensial maupun non esensial, yang dikaitkan dengan proses inflamasi dan infeksi. Tujuan penelitian ini adalah mengetahui profil asam amino esensial dan non esensial, serta mengetahui perbedaannya pada pasien terkonfirmasi COVID-19 severe dan non severe. Penelitian dilakukan dengan metode potong lintang di RSUPN Dr. Cipto Mangunkusumo dan Laboratorium HGRC pada Januari-Desember 2021. Total subjek adalah 128 subjek, terdiri dari 70 subjek (54,7%) kelompok severe dan 58 subjek (45,3%) kelompok non severe. Profil asam amino pada pasien terkonfirmasi COVID-19 severe dan non-severe, secara klinis ditemukan sedikit perbedaan dengan rentang effect size d 0,08-0,48. Tidak terdapat perbedaan bermakna keseluruhan profil asam amino antara kelompok severe dan non severe (p>0,05). Temuan ini diharapkan dapat memberi kontribusi dalam proses penyembuhan pasien terutama pada kondisi infeksi/inflamasi akut, serta menurunkan angka morbiditas dan mortalitas melalui penambahan asupan makanan atau terapi suplementasi potensial pada penderita dengan kadar asam amino yang lebih rendah

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Coronavirus Disease 2019 (COVID-19) is an infection, caused by SARS CoV-2 virus infection, and had been reported that cause death in many countries. Patients with COVID-19 infection, could have amino acid alteration, both in essential and non essential, which are associated in inflammation and infectious processes. The main objective of this study, was to know the essential and non essential amino acid profile, and to determine the differences in severe and non severe COVID-19 patients. This cross sectional study was conducted at Dr. Cipto Mangunkusumo National Central Public Hospital and HGRC Laboratory, from January-December 2021. There were 128 subjects, consisted of 70 subjects (54.7%) in severe group and 58 subjects (45.3%) in non severe group. The amino acid profile in severe and non-severe COVID-19 patients, clinically were found slight different, with the effect size range d 0.08-0.48. There was no significant difference in all amino acid, between severe and non severe group (p>0.05). These findings were expected to contibute in recovery process especially in infection/acute inflammation state, decreased the morbidity and mortality, through additional intake and potential supplementation therapy in lower amino acid patients."

"Latar Belakang. Obesitas merupakan faktor risiko luaran buruk pada pasien COVID-19. Sampai saat ini studi penilaian hubungan parameter obesitas berupa nilai lemak viseral, lingkar pinggang (LP), indeks massa tubuh (IMT), dan persentase lemak tubuh secara bersamaan dengan luaran COVID-19 menggunakan metode sederhana berupa bioimpedance analyzer (BIA) masih terbatas. Keempat variabel tersebut akan dinilai kemampuannya untuk memprediksi luaran buruk selama perawatan pasien COVID-19.Metode. Penelitian ini merupakan kohort prospektif dari 261 pasien COVID-19 ringan-sedang di RSUPN Cipto Mangunkusumo rawat inap sejak Desember 2020 hingga Maret 2021. Pasien dilakukan pemeriksaan BIA, LP, dan IMT saat admisi. Dilakukan analisis multivariat regresi logistik untuk menilai kemampuan nilai lemak viseral, persentase massa tubuh, IMT dan LP untuk memprediksi luaran buruk komposit yang mencakup ARDS dan mortalitas.Hasil. Didapatkan median nilai lemak viseral 10 (setara 100 cm2 ), lingkar pinggang 93 cm, IMT 26,1 kg/m2 , dan persentase lemak tubuh 31,5%. Berdasarkan multivariat regresi logistik, lingkar pinggang secara statistik bermakna sebagai faktor yang berpengaruh terhadap luaran buruk pada pasien COVID-19 [RR 1,04 (IK 95% 1,01-1,08)] bersama dengan derajat COVID-19 [RR 4,3 (IK 95% 1,9- 9,9)], skor NEWS [RR 5,8 (IK 95% 1,1-31)] saat admisi, dan komorbiditas [RR 2,7 (IK 95% 1,1-6,3)].Kesimpulan. Luaran buruk COVID-19 selama perawatan pasien COVID-19 terkonfirmasi dapat dipengaruhi oleh lingkar pinggang.

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Background. Obesity is a risk factor for adverse outcomes in COVID-19 patients. Until now, studies on assessing the relationship between obesity parameters in the form of visceral fat, waist circumference (WC), body mass index (BMI), and body fat percentage simultaneously with COVID-19 outcomes using a simple method such as bioimpedance analyzer (BIA) are still limited. The four variables will be assessed for their ability to predict adverse outcomes during the treatment of COVID-19 patients.

Method. This study is a prospective cohort of 261 mild-moderate COVID-19 subjects at Cipto Mangunkusumo General Hospital who were hospitalized from December 2020 to March 2021. Patients underwent BIA, WC, and BMI examinations upon admission. Multivariate logistic regression analysis was performed to assess the ability of visceral fat, body mass percentage, BMI, and WC to predict poor composite outcomes, including ARDS and mortality.

Results. The median value of visceral fat was 10 (equivalent to 100 cm2 ), WC was 93 cm, BMI was 26.1 kg/m2 , and body fat percentage was 31.5%. Based on multivariate logistic regression, WC was statistically significant as a factor influencing poor outcomes in COVID-19 patients [RR 1.04 (95% CI 1.01-1.08)] along with COVID-19 degree of severity [RR 4.3 (95% CI 1.9-9.9)], NEWS score [RR 5.8 (95% CI 1.1-31)] at admission, and comorbidities [RR 2.7 (95% CI 1.1) - 6.3)].

Conclusion. During the hospitalization of confirmed COVID-19 patients, poor outcomes can be affected by waist circumference."

"Latar belakang: Kondisi badai sitokin atau hiperinflamasi pada COVID-19 dapat berakibat fatal pada pasien. Inflamasi juga dapat menyebabkan gangguan koagulasi. Rasio netrofil limfosit (RNL) dan rasio platelet limfosit (RPL) telah diketahui dapat menjadi penanda inflamasi pada beberapa penyakit. Status koagulasi pasien dapat dilihat dari parameter nilai D-dimer. Peran penanda hayati yang dapat menggambarkan keadaan tromboinflamasi pada pasien COVID-19 tersebut perlu ditelaah lebih lanjut. Tujuan penelitian: Mengetahui hubungan nilai RNL, RPL dan D-dimer terhadap luaran tatalaksana pasien COVID-19 terkonfirmasi di RSUP Persahabatan.Metode penelitian: Analisis observasional kohort retrospektif terhadap pasien COVID-19 terkonfirmasi yang dirawat di RSUP Persahabatan secara total sampling diperoleh dari bulan Maret sampai dengan Juli 2020. Kami meninjau 214 rekam medis pasien COVID-19 terkonfirmasi yang memenuhi kriteria inklusi. Hasil penelitian: Rerata usia pasien pada penelitian ini adalah 54,35 tahun, didominasi oleh laki-laki sebanyak 60,7%. Status gizi pasien paling banyak adalah normal sebesar 54,7%. Proporsi pasien yang memiliki komorbid sebanyak 65,4%. Komorbid yang paling banyak adalah hipertensi, kedua adalah diabetes melitus. Derajat penyakit paling banyak adalah berat-kritis sebanyak 76,1%, diikuti sedang 20,1%, ringan 3,7%. Median lama rawat adalah 12 hari. Pasien meninggal sebanyak 60 orang (28%). Nilai median RNL, RPL dan D-dimer awal pasien adalah 5,75 (0,68-81,5), 243,5 (44,7-1607) dan 1140 (190-141300), secara berurutan. Terdapat hubungan antara nilai RNL (p=0,000), RPL (0,013) dan D-dimer (0,032) terhadap luaran pasien. Kesimpulan: Nilai RNL, RPL dan D-dimer awal perawatan pasien COVID-19 terkonfirmasi di RSUP Persahabatan berhubungan dengan luaran tatalaksana pasien.

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Backgrounds: Cytokine storm or hyperinflammation in COVID-19 can cause fatal outcome for patients. Imflammation also can cause hypercoagulation. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) have already known as inflammation marker in several diseases. Coagulation status in patients could be measured by D-dimer value. The role of biomarkers for that thromboinflammation in COVID-19 should be explored.

Aims: to know the association between NLR, PLR and D-dimer value with confirmed COVID-19 patients’ outcome in Persahabatan hospital, Jakarta

Methods: We performed observational retrospective cohort analysis of confirmed COVID-19 patients hospitalized in Persahataban hospital. Subjects by means of total sampling were confirmed COVID-19 patients between March till July 2020. We reviewed the medical record of 214 patients whom met the inclusion criteria.

Results: Mean age of patients in this study were 54,35 years old, dominated by males (60,7%). Most of the patients were with normal nutritional status (54,7%) and presented with comorbidity (65,4%). Diabetes melitus was the most frequent comorbidity, second was hypertension. Disease severity was severe to critical in 76,1% patients, 20,1% in moderate cases and 3,7% in mild case. Length of hospital stay was 12 days. Death patients were 60 (28%). The median of initial NLR, PLR and D-dimer value were 5,75 (0,68-81,5), 243,5 (44,7-1607) dan 1140 (190-141300), respectively. There were an association between NLR (p=0,000), PLR (0,013) and D-dimer value (p=0,032) with patients’ outcome.

Conclusions: There were association between NLR, PLR and D-dimer value on admission with confirmed COVID-19 patients’ outcome in Persahabatan hospital."

"Anosmia merupakan salah satu gejala COVID-19 yang spesifik. Mekanisme anosmia pada COVID-19 belum dapat dijelaskan dengan pasti. Beberapa studi melaporkan perubahan kemampuan penciuman disertai perubahan komposisi mikrobioma nasal. Saat ini studi mikrobioma nasal pasien COVID-19 yang mengalami gejala anosmia masih kurang. Penelitian ini bertujuan untuk mengetahui profil mikrobioma nasal pasien COVID-19 dengan dan tanpa anosmia di Laboratorium Mikrobiologi Klinik FKUI tahun 2021. Studi potong lintang ini dilakukan di Laboratorium Mikrobiologi Klinik FKUI Juli sampai September 2021 yang memenuhi kriteria inklusi dan tidak memenuhi kriteria eksklusi. Diagnosis anosmia ditegakkan menggunakan metode subjektif. Pengambilan spesimen usap nasofaring dan orofaring untuk pemeriksaan RT-PCR COVID-19 dan usap nasal untuk pemeriksaan mikrobioma dilakukan pada pasien tersangka COVID-19. Bila didapatkan hasil RT-PCR positif, maka pada spesimen usap nasal dilakukan pemeriksaan sekuensing 16S RNA-Next Generation Sequencing. Didapatkan 17 spesimen usap nasal dari subjek yang mengalami gejala anosmia dan 8 spesimen yang tidak mengalami gejala anosmia. Pada mikrobioma nasal pasien COVID-19 yang mengalami gejala anosmia terjadi berupa penurunan kelimpahan filum Actinobacteria, Ordo Propionibacteriales, Famili Propionibacteriaceae, genus Cutibacterium dan Peptoniphilus. Dari penelitian ini, terdapat perubahan komposisi mikrobioma nasal pada pasien COVID-19 dengan gejala anosmia.

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Anosmia is a specific symptom of COVID-19. The mechanism of anosmia in COVID-19 cannot be explained with certainty. Changes in nasal microbiome composition are associated with olfactory function. SARS-CoV-2 infection alters the respiratory microbiota and influence the susceptibility to COVID-19 infection. There are also changes in the composition of nasal microbioms of COVID-19 patients experiencing anosmia. Studies of the nasal microbiome in COVID-19 patients who experience symptoms of anosmia are rare. The aim of this study is to determine the nasal microbiome profile of COVID-19 patients with and without anosmia.

This cross-sectional study was conducted at the Clinical Microbiology Laboratory of the FKUI from July to September 2021 which met the inclusion criteria and did not meet the exclusion criteria. Anosmia is determined subjectively. Nasopharyngeal and oropharyngeal swab specimens for RT-PCR COVID-19 examination and nasal swabs for microbiome are collected from patients. If a positive RT-PCR result is obtained, then the nasal swab specimen is subjected to a RNA-Next Generation Sequencing. There were 17 nasal swab specimens from subjects with anosmic symptoms and 8 specimens without anosmic symptoms. In the nasal microbiome of COVID-19 patients who experience symptoms of anosmia, there is a decrease in the abundance of the Actinobacteria, Propionibacteriales, Propionibacteriaceae, Cutibacterium and Peptoniphilus. From this study, there were changes in the composition of the nasal microbiome in COVID-19 patients with anosmia symptoms."

"Latar Belakang. Banyak faktor yang memengaruhi derajat berat infeksi dan mortalitas dari infeksi Corona Virus Disease 2019 (COVID-19). COVID-19 menyebabkan kerusakan sel beta pankreas, namun sampai saat ini mekanisme kerusakan ini belum banyak diketahui. Metode untuk menilai fungsi sekresi dari sel beta pankreas adalah Homeostatic Model Assessment- β (HOMA-β) dan C-peptide. Tujuan. Mengetahui hubungan antara HOMA-β dan C-peptide saat admisi dengan luaran buruk pada pasien terkonfirmasi COVID-19 yang dirawat inap. Metode. Penelitian ini merupakan studi kohort retrospektif yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pasien terkonfirmasi COVID-19 (derajat ringan/sedang) berusia > 18 tahun, yang dirawat inap di RSCM Kiara dalam periode waktu September 2020 – Maret 2021, dengan HbA1c <6,5% serta tanpa riwayat diabetes sebelumnya, menjalani pemeriksaan HOMA-β dan C-Peptide. Ditentukan nilai titik potong keduanya untuk kemudian dilihat hubungannya dengan luaran buruk selama perawatan tersebut. Hasil. Dari 232 subyek yang memenuhi kriteria, terdapat 10(4,3%) subyek dengan luaran buruk. Median HOMA-β pada luaran buruk adalah 70,28% (RIK 32,25 – 132,11), sementara itu pada luaran baik adalah 121,6% (RIK 82,39 – 174,23). Median C-peptide pada luaran buruk dan baik berturut-turut adalah 2059 (RIK 1508 – 2762) dan 1647 (RIK 1107 – 2461). Nilai titik potong HOMA-β 80%, dengan AUC 0,702 (IK 95% 0,526-0,879) menunjukkan sensitifitas 60% dan spesifisitas 71,4%. Nilai Hazard Ratio (HR) dari HOMA-β <80 adalah 4,660 (p=0,017). Nilai titik potong C-peptide tidak dapat ditentukan karena AUC 0,555. Kesimpulan. Terdapat hubungan antara nilai HOMA-β saat admisi dengan luaran buruk selama perawatan pada pasien terkonfirmasi COVID-19, namun hubungan C-Peptide tidak didapatkan kemaknaannya dengan luaran buruk selama perawatan. Kata Kunci. COVID-19, C-Peptide, HOMA-β, Luaran buruk.

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Background. Many factors affect the severity of infection and mortality of Corona Virus Disease 2019 (COVID-19) infection. COVID-19 virus linked to pancreatic beta cells damage, yet the mechanism is still unclear. A method to assess the secretory function of pancreatic beta cells is based on Homeostatic Model Assessment- (HOMA-β) and C-peptide. Aim. Determine the relationship between HOMA-β and C-peptide values during admission in hospitalized confirmed COVID-19 patients with poor outcomes. Method. This is a retrospective cohort study conducted at Cipto Mangunkusumo Hospital (RSCM). Patients with confirmed COVID-19 (mild/moderate) who were hospitalized at the RSCM Kiara Hospital during the period September 2020 – March 2021, with HbA1c <6.5%, and without history of diabetes underwent HOMA-β and C-Peptide examination. The cut-off point for both was evaluated, furthermore the relationship with poor outcomes during hospitalization was assessed. Result. From 232 subjects met the inclusion and exclusion criteria, there were 10 (4.3%) subjects with poor outcomes. Median of HOMA-β in poor outcome group was 70.28% (IQR 32.25 – 132.11) while in good outcome group was 121.6% (IQR 82.39 – 174.23). The median of C-peptide on poor and good outcome were 2059 (IQR 1508 – 2762) vs. 1647 (IQR 1107 – 2461), respectively. The HOMA-β cut- off point was 80% showed AUC 0.702 (95% CI 0.526-0.879), with sensitivity 60% and specificity 71.4%. The Hazard Ratio (HR) of HOMA-β value <80% was 4.660 (p=0.017). The C-peptide cut-off point could not be determined because the AUC was 0.555. Conclusion. There is a significant relationship between the HOMA-β during admission and the poor outcome of hospitalized patients with confirmed COVID- 19 yet there is no significant relationship between C-Peptide and poor outcome."

"Latar belakang : COVID-19 telah menjadi suatu pandemik dan menyebabkan kematian cukup besar. Populasi anak dilaporkan kurang dari 5% dari seluruh kasus yang ada di tiap negara, namun tetap ada sebagian kecil yang mengalami gejala berat dan kritis dan berakhir pada kematian. Respons hiperinflamasi yang dikenal sebagai badai sitokin merupakan dasar terjadinya gejala berat pada COVID-19, dan temuan pada dewasa menunjukkan kadar IL-6 yang sangat dominan dan berkorelasi dengan luaran yang buruk. Ekstrapolasi hipotesis pada kasus dewasa belum dapat sepenuhnya menjelaskan kondisi berat dan kritis pada anak. Penelitian ini bertujuan untuk melihat profil klinis pasien anak yang mengalami sakit berat dan kritis, luaran serta kadar IL-6.Metode : Penelitian ini merupakan observasional kohort pada populasi anak sakit berat dan kritis yang masuk ke IGD dan PICU Kiara RSCM pada bulan Oktober 2020 hingga April 2021.Hasil : Sebanyak 80 kasus memenuhi subjek penelitian, dengan 21 kasus terkonfirmasi positif (kelompok kasus) dan 59 kasus negatif (kelompok kontrol). Pada kelompok kasus didapatkan terutama pada usia >10 tahun (9 subjek), disertai komorbiditas (20 subjek, terbanyak kelainan kelainan jantung bawaan), koinfeksi (10 subjek), mendapat imunosupresan (10 subjek), ARDS (13 subjek), renjatan (11 subjek), median skor PELOD-2 sebesar 3, serta luaran kematian pada 11 subjek. Median IL-6 pada kelompok kasus 30,3 pg/mL. Kadar IL-6 pada derajat berat COVID-19 bervariasi namun memiliki kecenderungan yang lebih tinggi pada kasus meninggal.Simpulan : Kelompok anak yang mengalami sakit berat dan kritis memiliki lebih banyak komorbiditas dan koinfeksi sehingga memengaruhi luaran serta kadar IL-6. Penilaian terhadap IL-6 sebagai prediktor kematian pada kasus anak sejalan dengan kasus dewasa, namun diperlukan penelitian lebih lanjut untuk melihat trend perubahan IL-6.

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Background:. The population of children suffered from COVID-19 is reported to be less than 5% of all cases in every country. There is still a tiny proportion who experience severe and critical symptoms and end up in death. A hyperinflammatory response known as a cytokine storm is the basis of severe symptoms in COVID-19 and findings in adults suggest that IL-6 levels are highly predominant and correlate with poor outcomes. Extrapolation from adult cases has not fully explained the severe and critical condition in children. This study aims to evaluate the clinical profile, outcomes, and levels of IL-6 in severe and critically ill children.

Methods: This study was an observational cohort of severe and critically ill children admitted to the emergency unit and PICU RSCM from October 2020 to April 2021.

Results: Eighty subjects met the inclusion criteria, with 21 confirmed COVID-19 cases (case group) and 59 negative cases (control group). In the cases group, mostly age  >10 years old (9 subjects), with comorbidities (20 subjects, mostly were congenital heart defects), coinfection (10 subjects), ARDS (13 subjects), shock (11 subjects), receiving immunosuppressants (10 subjects), and the median PELOD-2 score was 3. There were death in 11 subjects. The median IL-6 in the case group was 30.3 pg/mL. IL-6 levels vary in the severity of COVID-19 and have a higher tendency in cases of death.

Conclusion: The group of severely and critically ill children had more comorbidities and coinfections that affected the outcome and levels of IL-6. Assessment of IL-6 as a predictor of mortality in pediatric cases is in line with adult cases, but further research is needed."

"Latar Belakang: The Coronavirus disease 2019 (COVID-19) merupakan infeksi oleh severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) yang menjadi perhatian internasional pada Januari 2020. Manifestasi kasus ringan terjadi sekitar 81%, kasus berat sebanyak 14%. Mortalitas akibat pneumonia COVID-19 meningkat secara global akibat transmisi cepat dan gejala awal yang atipikal. Usia ≥ 60 tahun, jenis kelamin laki-laki dan komorbiditas merupakan faktor risiko untuk menjadi berat dan kematian sehingga dibutuhkan kontrol ketat pada pasien berisiko.Metode Penelitian: Penelitian ini merupakan penelitian retrospektif dengan studi potong lintang. Sampel penelitian merupakan pasien yang datang ke IGD dan terkonfirmasi pneumonia COVID-19 yang masuk dalam kriteria inklusi. Sampel pada penelitian ini adalah sebanyak 299 pasien.Hasil Penelitian: Pada penelitian ini didapatkan subjek penelitian adalah 299 dari 336 pasien yang masuk dalam kriteria inklusi. Jenis kelamin laki-laki sebanyak 162 orang (54,18%), nilai IMT obesitas I (29,77%) dan diikuti IMT normal (28,76%), paling banyak tidak memiliki komorbid dengan derajat pneumonia berat (60,2%) dan luaran pasien sebanyak 69,2% adalah hidup. Komorbid terbanyak yaitu hipertensi (30,77%), Diabetes mellitus (24%) dan kardiovaskular (14%). Usia median hidup pasien pneumonia COVID-19 di RS Persahabatan adalah 52 th (20-84) dan median usia meninggal adalah 59 th (28-92). Terdapat hubungan bermakna antara derajat klinis, HT, IMT dan DM terhadap luaran pasien pneumonia COVID-19 di RS Persahabatan.Kesimpulan: Usia median hidup pasien pneumonia COVID-19 di RS Persahabatan adalah 52 th (20-84) dan median usia meninggal adalah 59 th (28-92). Terdapat hubungan bermakna antara derajat klinis, HT, IMT dan DM terhadap luaran pasien pneumonia COVID-19 di RS Persahabatan.

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Background: The Coronavirus disease 2019 (COVID-19) is an infection by severe acute respiratory syndrome Coronavirus 2 (SARS-COV-2) which became international attention in January 2020. The manifestation of mild cases occurred about 81%, severe cases as much as 14%. Mortality of COVID-19 pneumonia increasing globally due to rapid transmission and atypical symptoms. Age of 60 years, male gender and comorbidities are risk factors for severe and death so that strict control is needed.

Methods: This study is retrospective cross-sectional study, which samples were patients who came to emergency room and confirmed of COVID-19. The samples are 299 patients who included of inclusion criteria.

Results: The sample of this study were 299 patients out of 336 patients who were include in inclusion criteria. Male (54.18%) are the most common, Obesity class I was the most common (29.77%) followed by normal BMI (28,76%) and didn’t have comorbid with severe (60.2%) and outcome are survived (69.2%). Hypertension (30,77%) is the most comorbid, followed by diabetes melitus (24%) and cardiovascular (14%). The median age of survivor is 52 (20-84) years old and median age of non survivor is 59 (28-92) years. There was relationship between severe pneumonia to respiratory rate and peripheral oxygen saturation. Gender, number of comorbidities and BMI were not related to the outcome. There is a relationship between the severity of pneumonia, obesity, diabetes and hypertension to the outcome.

Conclusion: The median age of survivor is 52 (20-84) years old and median age of non survivor is 59 (28-92) years. There was relationship between severe pneumonia to respiratory rate and peripheral oxygen saturation. Gender, number of comorbidities and BMI were not related to the outcome. There is a relationship between the severity of pneumonia, obesity, diabetes and hypertension to the outcome."